176 A Retrospective Analysis of Non-Muscle Invasive Bladder Cancer (NMIBC) Follow-Up Using Flexible Cystoscopy and the Role of the Charlson Co-Morbidity Index (CCI) in Improving Follow Up

Aim

1. A retrospective analysis of NMIBC follow-up using flexible cystoscopy during COVID-19.

2. Charlson Co-Morbidity Index (CCI) as a method of improving follow up.

Method

Online patient records were reviewed for 153 patients who attended Ayr University Hospital between 01/02/2020 and 01/05/ 2020 for check cystoscopy. We recorded the patients risk category and the number of months lapsed since their previous scope. Follow up schedules were compared with current NICE guidelines. CCI for each patient was calculated.

Results

The majority of the patients sampled had follow up adherent to NICE guidelines. Deviations were secondary to ‘allocation to an incorrect follow up schedule’, ‘late follow up’ and ‘non-compliance’. Incorrect allocation was due to both human error and clinical judgement. Clinical judgement included frail patients thought not to benefit from their current intensive schedule and patients with areas of suspicion warranting an earlier check. CCI scores ranged from 2–11. 25% of had a Charlson score of >6 - this predicts a 0% 10-year survival.

Conclusions

We hypothesise that patients with a CCI > 6 should be considered for less intensive follow up. Their co-morbid status makes them likely unsuitable for intervention if reoccurrence was identified.We are pleased with our current adherence to NICE guidelines. We recognise areas for improvement and have raised these at local meetings. We hope that the CCI can be used to ensure we practice realistic medicine and act in the best of the patient when deciding to follow up.

29 The Surgical Trainee Personality: Selected or Shaped?

Aim

This study aims to describe the personality differences between trainees at different stages prior to and during surgical training.

Method

The Mental Muscle Diagram Indicator was distributed electronically to doctors in training in South West London. A total of 553 trainees completed the personality questionnaire. Specifically, there were general surgery specialty (n = 53), core surgical (n = 254), and foundation trainees (n = 246). 52% of trainees were female.

Results

Women scored significantly higher in the Extraversion, Sensing and Judging personality domains (p < 0.0001), there were no significant differences between genders for ‘Thinking’. One-way ANOVA only showed a significant difference in the ‘Judging’ domain between grades. Tukey's test was performed showing the difference arose from FT to CST (p = 0.008). Two-way ANOVA showed an interaction between gender and grade for ‘Judging’ and as such simple main effects were performed, with alpha = 0.017 to control for type 1 errors. Significant differences were found in the Judging domain between genders during in FT (p=0.002) and CST (p=0.002), and there was no significant difference for SpRs (p=0.15).

Conclusions

This study demonstrated differences in personality types between trainee stages and gender. These differences appear to decrease as trainees progress through their training, although the cause of this is unclear.

11C-methionine PET aids localization of microprolactinomas in patients with intolerance or resistance to dopamine agonist therapy

PURPOSE

To assess the potential for ¹¹C-methionine PET (Met-PET) coregistered with volumetric magnetic resonance imaging (Met-PET/MR^CR) to inform clinical decision making in patients with poorly visualized or occult microprolactinomas and dopamine agonist intolerance or resistance.

PATIENTS AND METHODS

Thirteen patients with pituitary microprolactinomas, and who were intolerant (n = 11) or resistant (n = 2) to dopamine agonist therapy, were referred to our specialist pituitary centre for Met-PET/MR^CR between 2016 and 2020. All patients had persistent hyperprolactinemia and were being considered for surgical intervention, but standard clinical MRI had shown either no visible adenoma or equivocal appearances.

RESULTS

In all 13 patients Met-PET/MR^CR demonstrated a single focus of avid tracer uptake. This was localized either to the right or left side of the sella in 12 subjects. In one patient, who had previously undergone surgery for a left-sided adenoma, recurrent tumor was unexpectedly identified in the left cavernous sinus. Five patients underwent endoscopic transsphenoidal selective adenomectomy, with subsequent complete remission of hyperprolactinaemia and normalization of other pituitary function; three patients are awaiting surgery. In the patient with inoperable cavernous sinus disease PET-guided stereotactic radiosurgery (SRS) was performed with subsequent near-normalization of serum prolactin. Two patients elected for a further trial of medical therapy, while two declined surgery or radiotherapy and chose to remain off medical treatment.

CONCLUSIONS

In patients with dopamine agonist intolerance or resistance, and indeterminate pituitary MRI, molecular (functional) imaging with Met-PET/MR^CR can allow precise localization of a microprolactinoma to facilitate selective surgical adenomectomy or SRS.

O022 Application of customised 3D printed models to aid undergraduate teaching and surgical planning in hepatobiliary surgery

Introduction

3D-printing in maxillofacial surgery has been used for several years to construct bespoke prostheses prior to surgical procedures. This work aims to assess whether its role can be

expanded into undergraduate teaching and surgical planning in hepatobiliary surgery.

Methods

Four patient CT scans with liver and renal pathology were deemed eligible for printing. A computer aided design was constructed for each scan, segmenting the organ, lesion, and vasculature. One kidney and three liver models were printed. Production time of the models ranged from 31 to 106 hours. One liver model with the associated CT scan was shown to 20 doctors of varying experience. They were asked to complete a survey evaluating its potential in surgery, aiding patient education, and anatomy education. The remaining models were used in an anatomy tutorial for 6 medical students, who were requested to complete a pre-and-post-session survey evaluating the potential for the 3D models in anatomy education.

Results

An average rating from the NHS-staff survey was 6.9 for pre-operative planning, 8.65 for aiding anatomy education, and 9.15 for potential use in patient education. Following the tutorial with the models, 4 of the 6 students felt their overall understanding of liver anatomy improved. In particular, all students expressed increased confidence in hepatic segmentation anatomy.

Conclusion

Our work shows that 3D-printed models can provide benefit in aiding clinical teaching and patient information. Future work will focus on use of the models as an aid to patient education in an outpatient setting.

Take-home message

3D-printed models have a future in aiding anatomy education and hepatobiliary surgical planning. Further research can consolidate their applications.

The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme: a pilot randomised controlled study

Funding Acknowledgements

Type of funding sources: None.

Background

Atherosclerotic risk factor modification plays an important role in reducing adverse outcomes in patients with atherosclerotic disease1. Despite the high prevalence of peripheral arterial disease (PAD) and strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive structured treatment for their atherosclerotic risk factors than patients with coronary artery disease2,3.

Purpose

We aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors.

Methods

This is a pilot randomised controlled study comparing a risk factor modification intervention programme to standard healthcare, for the reduction of modified risk factors in PAD patients. Patients randomised to the intervention arm underwent a 12-week supervised programme adjusting their risk factors. Primary outcome was patients reaching target risk factor improvement.

Results

Seventy-five patients were randomised. 36 were allocated to Standard Healthcare. 39 completed a 12-week Structured Programme. There was no significant difference between groups in baseline demographics, incidence and severity of risk factors, mobility and quality of life.

At 12-weeks the intervention group showed a significant improvement in target body weight (6.7±9.57 p=0.002), waist circumference (7.4±9.5 p=0.001), HbA1c (4.12±7.22 p=0.009), total cholesterol (0.63±0.99 p=0.004), low-density lipoprotein (0.59±1.040 p=0.00), triglycerides (0.24±0.38 p=0.005), Mediterranean diet score (2.48±1.35 p=0.0001), Absolute Walking Distance (8.2±7.8 p=0.0001), Claudication Distance (9.2±7.4 p=0.0001). There was no significant difference in the change of any of the other risk factors.

Conclusion

Risk factor modification intervention programme can significantly aid PAD patients reach their target risk factor improvement goals.

683 UNDERSTANDING HOW DISCHARGE SERVICES FOR OLDER PATIENTS CAN BRIDGE THE GAP BETWEEN HOSPITAL, COMMUNITY AND SOCIAL CARE

Introduction

UK policy recommends that discharge support is provided by hospital, community and social care staff. However, there is a lack of understanding regarding how these multiagency hospital discharge services work in practice, how they can be sustained and what service stakeholder experiences of them are. This research aimed to understand how integrated discharge services work and the views and experiences of stakeholders.

Method

A qualitative case study of a supported integrated hospital discharge service (SIHDS) for older people was undertaken, which involved interviews with service staff (hospital, community and social care), patients and carers. Staff, patients and carers were interviewed on their experiences of SIHDS. Staff also took part in a process mapping exercise to understand how the service works. Interviews were analysed using thematic analysis. Ethical approval was obtained for this research.

Results

A variety of staff (n = 14) and patients aged over 60 years (n = 11) and their informal carers/family members (n = 4) were interviewed. Three main staff themes emerged from the findings: 1. Preparedness for discharge and impact of discharge service; 2. Integration and impact on patient pathway and 3. Organisational aspects. The three main patient/carer themes were: 1. Support for patients; 2. Patient Outcomes and 3. Information exchange. The findings demonstrated that: SIHDS was seen as important to allow patients to be discharged home in a timely and safe manner; that communication is important at all levels of a SIHDS and SIHDS need to continuously evolve to provide patient centred care.

Conclusion

The findings from this qualitative case study allow the complexities involved in SIHDS to be understood from the experiences and perspectives of multiagency staff, patients and carers. It shows SIHDS are complex, but useful to overcome gaps between services. However, to effectively sustain a patient centred service it is important to regularly review and develop SIHDS.

682 IMPACT OF DISCHARGE INTERVENTIONS FOR OLDER PATIENTS LEAVING HOSPITAL: A SYSTEMATIC REVIEW OF REVIEWS

Introduction

The UK has an aging population and there is an increasing need for additional care and support services for elderly patients discharged from hospital. Despite a large evidence base on different discharge services there is inconsistent findings on their effectiveness. This systematic review of reviews aimed to evaluate the impact of a variety of discharge interventions on older people leaving hospital.

Method

Ten databases were searched (including Medline and The Cochrane Library) using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Only systematic reviews of interventions for people aged over 60 years that provided additional support or adapted their discharge processes were included. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. Abstract, title and full-text screening was conducted independently by two reviewers. Interventions were categorised by intervention type and a narrative synthesis was conducted on data extracted.

Results

Of the 8,748 title and abstracts reviewed, 859 full texts were assessed for eligibility, of these 91 were taken forward to quality assessment and 66 moderate or high-quality reviews were included in the final synthesis. Interventions were categorised into 10 types and had varying impact on outcomes. A statistically significant positive impact on the outcomes of interest was found for: Interventions providing ‘rehabilitation, therapy or care at home (or in the community) around the time of discharge’ reducing length of stay; ‘primary care interventions’, ‘Discharge planning/coordination or case management’ and ‘patient education’.

Conclusion

This systematic review of reviews shows that different types and configurations of discharge interventions can benefit older patients in multiple ways when compared to usual care and highlights which intervention types make no difference or have negative impacts. These findings will help to inform the development of new discharge interventions and the direction of future research.

676 OPTIMISING ENGAGEMENT OF OLDER ADULTS IN AN ONLINE PHYSICAL ACTIVITY PROGRAMME TO IMPROVE COGNITION: A QUALITATIVE STUDY

Introduction

Maintaining physical activity is a modifiable risk factor for cognitive impairment. However, despite numerous public health interventions, older adults do not routinely meet activity guidelines. Online interventions offer an alternative means of engaging with this group. The role of an online intervention holds particular value in the context of a global pandemic where people have become accustomed to digital living. Furthermore, such an intervention negates barriers frequently faced by older adults in attending face to face interventions, whilst providing an economically viable option. This study explored the factors which maximise engagement in an online programme to promote physical activity.

Methods

A qualitative study was conducted with adults aged 50 and over. Individual were recruited through the online UK PROTECT study cohort. Four focus groups (n = 21) examined key contributors to engagement with a digital programme to promote physical activity. Iterative Categorization was utilised to identify categories and themes of the focus group data. Semi-structured interviews were subsequently conducted (n = 5) whereby participants were asked to comment on a concept-stage online intervention.

Results

Four major themes emerged from the focus group data: interaction at the fore, incentives as foundations, fitting around me and identity is critical. The semi-structured interviews identified further key areas of programme acceptability and specific needs for enhancing engagement.

Conclusions

Older adults are open to using digital physical activity programmes, with the recent COVID-19 pandemic driving an appetite for online delivery. Any intervention must be tailored to individual usability preferences and take account of the fitness, health and lifestyle needs specific to older adults. Furthermore, the conceptual-stage intervention used in this study was found to be acceptable, with key changes needed to maximise engagement.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

A139 EQUITY IN ACCESS TO COLORECTAL CANCER SCREENING IN NOVA SCOTIA

Background

Population-based colorectal cancer (CRC) screening programs aim to minimize inequities in participation through universal access, however, there remain disparities associated with low education, socio-economic status, and population centre. In the United States racialized groups have lower screening participation, and Black and Indigenous adults have higher CRC mortality. There is no Canadian data on racialized group participation in CRC screening because racial and ethnic data is not routinely collected. The Nova Scotia Colon Cancer Prevention Program (NSCCPP) mails fecal immunochemical tests (FIT) biennially to all residents aged 50–74 and allows for optional self-identified race and ethnicity.

Aims

To determine whether participation rates in the NSCCPP differ on the basis of race/ethnicity, age, sex, or population centre. In this preliminary analysis we report screening participation on the basis of race/ethnicity.

Methods

A retrospective cohort study was performed using the NSCCPP database to identify screen-eligible adults who returned a FIT to the program (i.e. participated) from 2011 to 2021. Racialized groups were identified based on self-identification form results allowing for multiple category selections. Race/Ethnicity was categorized as White, Black/African Canadian, Indigenous, Asian, Middle Eastern. The 2016 Canadian census was used to estimate the screen-eligible population (age 50–74) and race/ethnicity group population sizes. Unique participants were identified as individuals who returned one or more FITs in the study period. Unique participants were compared to the screen-eligible population to estimate participation over the 10-year study period.

Results

508,533 FITs were returned over 10 years by 208,702 unique participants. The number of annual FITs returned ranged from 14,066 in 2011 to 65,746 in 2019. Participants were 56% female, 44% male, with a mean age 62.8 (± 7.0). FIT status was 89% negative, 7% positive, and 4% indeterminate. 96% (n=490,398) of participants provided self-identification data. Table 1 provides the screen-eligible population, unique participants, and FIT participation over the 10-year study period all characterized by race/ethnicity. Over 10 years, 59% of the eligible population participated in CRC screening by returning at least one FIT.

Conclusions

CRC screening participation by race/ethnicity in Canada is unknown. This analysis of the NSCCPP suggests that participation by racialized individuals including Black/African Canadian, Asian, and Indigenous, are lower relative to White individuals. Further analyses will explore race/ethnicity and gender in terms of temporal and geographic trends.

Table 1.

Funding Agencies

None

A26 DECONSTRUCTING DISTRESS: STAKEHOLDER ENGAGEMENT FOR EVIDENCE-BASED, PATIENT-CENTERED INTERVENTIONS FOR THE MANAGEMENT OF IBD-ASSOCIATED PSYCHOLOGICAL DISTRESS

Background

The growing prevalence of Inflammatory Bowel Disease (IBD) along with increasing complexity of providing high-quality, patient-centered care within a resource-constrained healthcare environment presents a major challenge. IBD-related psychological distress (IBD-PD) is the emotional impact of IBD and is associated with mental health disorders, increased disease severity, and premature mortality. With estimates of nearly 90% of IBD patients experiencing PD, the inability to provide high-quality, person-centered care for IBD-PD that is proportionate to clinical need is a significant care gap in the Canadian healthcare system.

Aims

To generate stakeholder-derived data to inform the design and development of stepped-intensity, cognitive behavioral therapy-based interventions for IBD-PD using evidence-based, patient–centered interventions and implementation strategies.

Methods

Virtual semi-structured interviews were conducted from September to October 2021. The interview guide was developed iteratively by researchers, IBD care providers, and patient research partners and guided by the COM-B Model of Behaviour and the Theoretical Domains Framework. Questions assessed perceptions, experiences, barriers, and facilitators to accessing IBD-PD care. Adults diagnosed with IBD were recruited from academic centers across Canada. Interviews were co-facilitated by a researcher and patient research partner, audio recorded, and transcribed. Using thematic analysis, codes were generated to identify themes using an inductive approach.

Results

As of October 2021, six interviews have been completed, with data collection ongoing. The mean participant age was 34.3 years (range 21–55 years) with 100% of respondents being female. The majority of participants worked full time (4/6, 67%) and all had completed at least high school. Diagnoses of Crohn’s Disease (3/6, 50%) and ulcerative colitis (3/6, 50%) were evenly distributed. Thematic analyses identified five major themes: 1) Lack of holistic care and acknowledgement of IBD-PD; 2) System-level and financial barriers to psychological support; 3) Lack of psychological support from providers with an understanding of IBD; 4) Preference for individualized virtual-based support; 5) Heavy reliance on informal support structures (caregivers) due to lack of access to formal psychological support.

Conclusions

As part of human-centered design, stakeholder engagement is key to understanding behavioral, social, attitudinal, and environmental barriers and facilitators for accessing IBD-PD care. Interviews are ongoing and specific intervention functions will be defined and incorporated into patient-centered implementation strategies.

Funding Agencies

None

A96 RAPID IMPLEMENTATION OF AN EVIDENCE-BASED, VIRTUAL COVID-19 VACCINE EDUCATION CLINIC AT NOVA SCOTIA COLLABORATIVE INFLAMMATORY DISEASE CLINIC (NSCIBD)

Background

Rapid adaptation of clinical management as well as policy decisions in relation to implementation of COVID-19 vaccination programs for persons living with IBD has been required throughout the pandemic.

Aims

To meet the need for public health-mandated COVID-19 vaccine education for patients living with IBD in Nova Scotia a novel, evidence-based, virtual COVID-19 vaccine educational intervention was developed, implemented, and evaluated.

Methods

An observational, cross sectional, implementation-effectiveness study was conducted at the NSCIBD program between April and July, 2021. The educational intervention consisted of a standardized evidence-based letter describing risks and benefits of COVID-19 vaccine emailed to patients in advance of a virtual clinic appointment. Virtual appointments were offered to all patients contacting the NSCIBD program with questions or concerns about vaccination. During these virtual visits standardized, evidence-based information was provided by a gastroenterologist (n=2) or IBD nurse practitioners (n=2) and patients were provided with an opportunity to address specific disease and treatment related concerns. Following the session, a link to an anonymous questionnaire was distributed via email to evaluate key implementation metrics including satisfaction, appropriateness, usefulness, perceived impact on knowledge and vaccine hesitancy, and recommendations for improvement. Data analysis was descriptive. Group means were expressed as proportions for categorical variables and means for numerical variables.

Results

A total of 298 patients participated in a virtual patient education session of which 265 provided a valid email address and invited to participate in the on-line survey. The response rate was 49% (131/265). Before the session, 48.9% (64/131) expressed vaccine hesitancy. Twenty-six percent (35/131) expressed concerns relating to risks versus benefits of COVID-19 vaccines. Ninety-one percent (119/131) of respondents found the education program helpful. The proportion of those willing to get vaccinated rose from 61% (pre) to 86.3% (post). Only 1.5% (2/131) indicated they would not get vaccinated. Seventy-seven percent (101/131) found the written and virtually administered educational content to be satisfactory. Eighty-eight percent (115/131) of respondents were willing to participate in similar types of virtual education offerings in the future.

Conclusions

Implementation of an evidence-based, multidisciplinary, virtual COVID-19 vaccination education intervention was perceived to be feasible, acceptable, and effective by IBD patients. Further research on innovative, evidence-based, multidisciplinary educational interventions and the impact of these interventions on IBD clinical outcomes are needed.

Funding Agencies

None

A77 IMPLEMENTATION OF GUT LINK-IBS; RESULTS OF A SEMI-STRUCTURED INTERVIEW OF PRIMARY CARE PROVIDERS

Background

The Division of Digestive Care and Endoscopy in Halifax, Nova Scotia has had longstanding challenges with GI referral volume outstripping divisional capacity resulting in limited access to specialist care. Many referrals for functional bowel disorders (FBD) are returned to referring providers. Although this helps rationalize limited system resources, it often impairs access to appropriate and necessary GI care. The co-development and implementation of clinical care pathways across gastroenterology and primary care may help to improve access to high-quality GI care.

Aims

The project aimed to engage primary healthcare providers (PHCPs) to identify environmental and behavioral barriers and facilitators for managing undifferentiated lower GI disorders in primary care. Data generated from stakeholder engagement will be used to develop, implement, and evaluate strategies for referral and management of FBD. A real-world, functional clinical care pathway that supports the implementation of evidence-based practices in the diagnosis and management of functional GI conditions within primary care will enhance care and timely access to specialist.

Methods

This is a qualitative study using semi-structured interviews of PHCPs working in Nova Scotia. Interview questions were developed and guided by the evidence-based implementation science frameworks. Physicians were recruited through existing primary care networks. Participants were offered a Zoom™virtual semi-structured interview. A brief intake questionnaire was administered to collect baseline demographics. Interviews were recorded and transcribed for data analysis. Data were categorized into coding schemes and themes were created using an inductive coding approach.

Results

As of October 2021, 9 interviews have been conducted. Average participant age was 44 years, with the majority identifying practice in a group or collaborative care setting (n=7, 78%). Five worked in urban practice settings and the remainder in rural areas. Preliminary major themes included:

1. A lack of satisfaction with access to gastrointestinal care, with most physicians noting it to be worse than access to other specialist services.

2. Management of FBDs were felt to be within the scope of primary care practice

3. Access to diagnostic tests like fecal calprotectin with appropriate education on its use as a diagnostic tool would be useful.

4. PHCP’s suggested care pathways be easy to use, require minimal time, and ideally be implemented within their pre-existing EMR or in paper form.

Conclusions

PHCPs acknowledge a significant burden of undifferentiated lower GI complaints in their practice and poor access to gastroenterology services. All participants were open to helping develop and use a clinical care pathway for the investigation and management of undifferentiated lower GI symptoms. Data collection and analysis are ongoing.

Funding Agencies

None

A84 SECURE ELECTRONIC DOCUMENT SIGNING UPTAKE IN BIOLOGIC PRESCRIBING FOR IMMUNE MEDIATED DISEASES

Background

The COVID-19 pandemic drastically impacted workflows in gastroenterology practice. Physicians managing immune-mediated diseases (IMDs) must complete special authorization (SA) and prescription renewal (Rx) forms for patients on biologic therapy. This adds significant administrative burden potentially leading to delays in therapy initiation and care continuity. Historically, document completion has largely been paper-based, with forms faxed between patient support programs (PSPs) and physician offices. Disruption of normal office processes during the pandemic necessitated the movement of existing paper-based workflows online. The use of secure electronic document signing (SEDS) platforms has allowed physicians to receive and complete documents digitally.

Aims

To evaluate the impact of SEDS-based biologic documentation on clinical practice. Objectives were 1) to determine if the use of SEDS platforms increased timeliness of document returns compared to traditional workflows 2) assess whether SEDS usage is acceptable and sustainable and 3) assess MD satisfaction with SEDS platforms.

Methods

This was a retrospective audit of SEDS and paper-based biologic document workflows from a single PSP (Abbvie Care). Outcomes of interest were the number of documents completed monthly using SEDS, new monthly users, and the number of active monthly users between April 1, 2020-March 31, 2021. Time (days) to SEDS completion (vs. paper process) was determined by reviewing timepoint data for SA and Rx documents from May 2019-January 2020 (‘pre- SEDS’) and for SEDS documents from May 2020-January 2021(‘SEDS’). The return time (RT) was defined as the time between date sent to a physician’s office by the PSP to the date returned to the PSP. Documents in the pre-SEDS cohort with a RT exceeding 30 days were excluded

Results

In totality, 5573 SA and Rx documents were completed by 383 physicians using the SEDS platform from April 2020-March 2021. A mean of 14.6 (sd 21.8) documents were signed per physician. The number of monthly electronic documents processed increased from 104 in April 2020 to 800 in March 2021. Active monthly users increased from 24 in April 2020 to 213 in March 2021 (31 new users monthly). A total of 19,387 paper documents were processed during the ‘pre-SEDS’ period and 3,317 electronic documents processed in the ‘SEDS’ period. The mean RT in the ‘pre-SEDS’ period was 8.03 days (Sd 8.2) and the ‘SEDS’ period was 1.11 days (sd 2.6).

Conclusions

This data demonstrates acceptability, appropriateness, and improved processing efficiency of a SEDS platform improving timeliness of patient care. Next steps in this research include surveying physicians to understand the work-flow impact of SEDS, functionality, long-term sustainability, satisfaction and impacts on disease related outcomes.

Funding Agencies

None